Flooring design for dementia

Good flooring design can make life easier for people living with dementia, by reducing anxiety and limiting the risk of slips and trips, discovers Kay Hill

It’s easy to think that unless you are designing a care home or a hospital ward, the needs of people with dementia are largely irrelevant. But statistics from Alzheimer’s Society show just how fast this sector of the population is growing. Currently, there are an estimated 850,000 people with dementia in the UK, with that figure set to rise to one million by 2025 and, unless the hoped-for cure is found, to two million by 2051. By way of comparison, there are 1.2 million wheelchair users in the UK.

More than two-thirds of those who have been diagnosed with dementia continue to live in the community, negotiating shops and railway stations, libraries and council offices as they go about their daily lives. Good design is just one of a whole raft of measures that can make life less confusing and threatening for those living with the condition.

‘Many people with dementia still live at home and are independent enough to look after themselves, so it is essential that all public buildings are designed with these considerations in mind,’ says Elizabeth Butcher, marketing manager for Tarkett’s Healthcare & Education segment.

A flooring design using Forbo’s Eternal Material Pebble Stucco and Eternal Wood Shadow Oak, both accredited by the DSDC. Wood patterns have a homely atmosphere that encourages independence and promotes calm, while the two materials have similar light reflective values so will not be perceived as an obstacle

‘Through good design we can make spaces easier to navigate, and in turn accessible, for those living with dementia, helping to prolong independence for as long as medically possible. In addition, many of the principles in good dementia design also help those with other ageing or visual impairments, increasing the benefit even further.’

The growing prevalence of dementia in this country has been the catalyst for increased interest in how to future-proof the design of public buildings and spaces – it’s not just a consideration for design in care and cure environments.’

The problem faced by architects, is that many beautiful flooring ideas might actually cause distress to those with dementia and increase the risk of falls. High-gloss flooring finishes, such as traditional shiny varnishes or high-gloss laminate, are perceived by people with Alzheimer’s and similar conditions as being wet, so they will be uncertain and fearful about walking on it, or won’t want to step on it at all, worried that it is freshly mopped and drying. Pretty, sparkling resin finishes or natural stone with large flecks in can be problematic too; it is distracting to people who may stoop down to try to pick up the flecks. Spongy floors can cause uncertainty, while some stone and tile floors can cause echoing noise that may be confusing or frightening.

While the use of bright, plain colours can be stimulating and improve mood, sudden changes in flooring colour can give the impression of a step, causing elderly people to trip as they high-step unnecessarily, while motifs in floors, deep shadows or very dark colours can be perceived as holes, causing those with dementia to try to walk around what they think are obstacles. Abstract patterns can simply seem confusing and dangerous to those with perceptual difficulties, and wood-look finishes need to be chosen with care, as grain patterns that are too vivid or that look like rustic, can also cause worry.

‘Incorrect wood designs can often create the illusion of an unstable floor which someone living with dementia will try to avoid, while really low contrast wood designs will appear institutional, with the wood grain disappearing altogether, ultimately missing the brief altogether,’ says Elizabeth Butcher. ‘Choosing the right flooring pattern in good dementia design is more essential than most realise.

When done correctly it can achieve positive outcomes such as reduced anxiety, easier navigation and the reduction of slips, trips and falls.’

Experts agree that the most important consideration is contrast. The University of Stirling has been doing a considerable amount of work into how design can help those with dementia, and Lesley Palmer, chief architect at its Dementia Services Development Centre, explains: ‘What we look to achieve is a minimum of contrast of 30 points of light reflectance values between the floor and the wall. This improves visibility, improves legibility of the three-dimensional aspect of the space and helps people both with dementia and normal age-related sight loss or visual impairment to read, perceive and move through the environment safely.’

Carpets give a homely feel that is proven to help residents in care homes keep active for longer. Here Scala broadloom carpet by Lano was installed at Avery Healthcare’s The Hawthorns retirement village in Eastbourne. There is good contrast against skirtings and walls and obstacles like the reception and pillar are highlighted by the carpet design

A solid understanding of how the light reflectance values (LRV) work is vital. There needs to be a large contrast between floors and walls (which is why flooring surfaces that run up the wall, while great for hygiene, are confusing for those with perceptual difficulties), but where different flooring finishes meet, in doorways for example, there needs to be low contrast, and no prominent or shiny joining strips that could be seen as needing climbing over.

Conversely, vivid contrasts can highlight potential dangers such as a staircase or discourage those with dementia from wandering into private areas. ‘The single most important aspect of flooring for people with dementia is getting the tonal continuity right in terms of how flooring finishes work together,’ says Mark Jackson. ‘Flooring can be considered “dementia friendly”, that is with no big patterns or high gloss finishes, but floor finishes that work together should be within eight steps of LRV (and no more than 10) to avoid high stepping and the possibility of trips or falls.’

There’s also a danger that in trying to eliminate every possible risk, architects will end up specifying a floor that looks totally institutional – and that too has its risks when it comes to care home residents. All the research suggests that people stay more active for longer if the place they are living is more like a home and less like a hospital. Tarkett’s research paper Designing Supportive Care Homes notes: ‘As a living space, the care home should have a comfortable, domestic feel without institutional cues.

While hospital patients require a contamination-free environment for their treatment, older people need to be cared for rather than cured. They do better in surroundings that are not sterile but rich with homely references to remind and reassure.’

‘It is absolutely possible to create attractive environments within the principles of good dementia design,’ stresses Butcher. ‘Knowing the rules and then correctly applying them to the vast array of colours and patterns on the market means environments and their interiors can be exactly as you desire. Good dementia design doesn’t cost more, it saves money… but most importantly improves the lives of many.’